五禽戏联合呼吸肌锻炼在COPD稳定期患者中的应用研究

doi:10.3760/cma.j.issn.1007-1245.2024.08.036

摘要/Abstract

摘要：

目的　探究五禽戏联合呼吸肌锻炼对慢性阻塞性肺疾病（COPD）稳定期患者呼吸困难程度及肺功能的影响。方法　前瞻性分析驻马店市中医院2020年10月至2022年10月收治的86例COPD稳定期患者，按照随机数字表法分为两组，每组43例。对照组男23例，女20例，年龄（70.31±3.54）岁；观察组男25例，女18例，年龄（70.25±3.61）岁。对照组开展呼吸肌锻炼，观察组在对照组基础上联合五禽戏训练，均持续训练3个月。比较两组呼吸困难程度、肺功能、血气指标、运动耐力、生活质量水平。采用χ²检验、t检验、秩和检验。结果　两组干预前呼吸困难程度、肺功能、血气指标、运动耐力、生活质量比较差异均无统计学意义（均P>0.05）。干预3个月后，两组患者改良版英国医学研究委员会呼吸困难量表（mMRC）分级比较差异有统计学意义（Z=2.131、P=0.033）；观察组的第1秒用力呼气量（FEV₁）、用力肺活量（FVC）、FEV₁/FVC分别为（3.11±0.17）L、（3.33±0.36）L、（93.39±5.86）%，均高于对照组的（2.04±0.15）L、（2.26±0.24）L、（90.27±5.11）%，差异均有统计学意义（t=30.948，P<0.001；t=16.217，P<0.001；t=2.631，P=0.010）；观察组的经皮动脉血氧饱和度、动脉血氧分压分别为（91.93±5.73）%、（82.83±7.14）mmHg（1 mmHg=0.133 kPa），均高于对照组的（86.84±5.09）%、（70.74±6.77）mmHg，动脉血二氧化碳分压低于对照组［（44.15±4.03）mmHg比（47.44±4.31）mmHg］，差异均有统计学意义（t=4.355，P<0.001；t=8.057，P<0.001；t=3.656，P<0.001）；观察组的6 min步行试验与对照组比较［（438.69±26.73）m比（422.86±25.26）m］，差异有统计学意义（t=2.823，P=0.006）；观察组圣·乔治呼吸问卷（SGRQ）中症状、活动、疾病影响评分分别为（43.76±3.60）分、（42.52±3.72）分、（41.06±3.17）分，均低于对照组的（52.07±4.19）分、（53.08±4.13）分、（50.15±3.73）分，差异均有统计学意义（t=9.864，P<0.001；t=12.458，P<0.001；t=12.177，P<0.001）。结论　五禽戏联合呼吸肌锻炼能够减轻COPD稳定期患者呼吸困难程度，调节血气指标，提高运动耐力，改善肺功能及生活质量。

关键词:

慢性阻塞性肺疾病稳定期, 五禽戏, 呼吸肌锻炼, 呼吸困难, 肺功能

Abstract:

Objective　To investigate the effects of five-animal exercises combined with respiratory muscle exercise on the degree of dyspnea and lung function in patients with stable chronic obstructive pulmonary disease (COPD). Methods　A prospective analysis was conducted on 86 stable COPD patients admitted to Zhumadian Hospital of Traditional Chinese Medicine from October 2020 to October 2022. They were divided into two groups by the random number table method, with 43 patients in each group. The control group included 23 males and 20 females, aged (70.31±3.54) years. The observation group included 25 males and 18 females, aged (70.25±3.61) years. The control group underwent respiratory muscle exercise, and on the basis, the observation group was trained in combination with five-animal exercises for 3 months. The degree of dyspnea, lung function, blood gas indicators, exercise endurance, and quality of life were compared between the two groups. χ² test, t test, and rank sum test were used. Results　There were no statistically significant differences in the degree of dyspnea, lung function, blood gas indicators, exercise endurance, and quality of life between the two groups before intervention (all P>0.05). After intervention, there was a statistically significant differences in the classification of the modified British Medical Research Council Dyspnea Scale (mMRC) between the two groups (Z=2.131, P=0.033). The forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC in the observation group were (3.11±0.17) L, (3.33±0.36) L, and (93.39±5.86)%, which were higher than (2.04±0.15) L, (2.26±0.24) L, and (90.27±5.11)% in the control group, with statistically significant differences (t=30.948, P<0.001; t=16.217, P<0.001; t=2.631, P=0.010). The pulse oxygen saturation and arterial partial pressure of oxygen of the observation group were (91.93±5.73)% and (82.83±7.14) mmHg (1 mmHg= 0.133 kPa), which were higher than those of the control group [(86.84±5.09) % and (70.74±6.77) mmHg]; the arterial partial pressure of carbon dioxide was lower than that of the control group [(44.15±4.03) mmHg vs. (47.44±4.31) mmHg], with statistically significant differences (t=4.355, P<0.001; t=8.057, P<0.001; t=3.656, P<0.001). There was a statistically significant difference in the 6-min walking distance between the observation group and the control group [(438.69±26.73) m vs. (422.86±25.26) m] (t=2.823, P=0.006). The symptom, activity, and disease impact scores of the St. George's Respiratory Questionnaire (SGRQ) in the observation group were (43.76±3.60) points, (42.52±3.72) points, and (41.06±3.17) points, which were lower than those in the control group [(52.07±4.19) points, (53.08±4.13) points, and (50.15±3.73) points], with statistically significant differences (t=9.864, P<0.001; t=12.458, P<0.001; t=12.177, P<0.001). Conclusion　The combination of five-animal exercises and respiratory muscle exercise can alleviate the degree of dyspnea in stable COPD patients, regulate the blood gas indicators, and improve the exercise endurance, lung function, and quality of life.

Key words:

Stable phase of chronic obstructive pulmonary disease, Five-animal exercises, Respiratory muscle exercise, Dyspnea, Lung function

陈丽华白贺芳白丽.

五禽戏联合呼吸肌锻炼在COPD稳定期患者中的应用研究 [J]. 国际医药卫生导报, 2024, 30(8): 1403-1407.

Chen Lihua, Bai Hefang, Bai Li.

Study on the application of five-animal exercises combined with respiratory muscle exercise in stable COPD patients [J]. International Medicine and Health Guidance News, 2024, 30(8): 1403-1407.

参考文献

[1] 陈松美. 八段锦联合多元呼吸康复训练对老年慢性阻塞性肺疾病患者肺功能、mMRC评分及生活质量的影响[J]. 检验医学与临床,2020,17(18):2669-2672,2675. DOI:10.3969/j.issn.1672-9455.2020.18.022.
[2] Okura K, Iwakura M, Shibata K, et al. Diaphragm thickening assessed by ultrasonography is lower than healthy adults in patients with chronic obstructive pulmonary disease[J]. Clin Respir J, 2020, 14(6): 521-526. DOI: 10.1111/crj.13161.
[3] 闫玉侠,孔晓洁,李苗苗,等. 基于呼吸训练-运动康复锻炼干预对慢性阻塞性肺疾病急性加重期患者肺功能及生活质量的影响[J]. 中华保健医学杂志,2021,23(2):170-172. DOI:10.3969/j.issn.1674-3245.2021.02.018.
[4] 田蕾,郭羽,陈海军. 渐进抗阻吸气肌训练对脑卒中伴慢性阻塞性肺疾病患者呼吸力学、肺功能及mMRC分级的影响[J]. 中国康复,2021,36(12):729-733. DOI:10.3870/zgkf.2021.12.006.
[5] 廖佳星,龚放华,熊子欣,等. 正念减压疗法联合肺康复训练对老年慢性阻塞性肺疾病稳定期患者疲劳程度及心肺功能的影响[J]. 实用心脑肺血管病杂志,2021,29(7):24-28. DOI:10.12114/j.issn.1008-5971.2021.00.153.
[6] 申营胜,王妍炜,于素平,等. 基于五禽戏之鸟戏的康复呼吸操对大叶性肺炎患儿肺功能的影响[J]. 护理学杂志,2022,37(5):17-20. DOI:10.3870/j.issn.1001-4152.2022.05.017.
[7] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等. 慢性阻塞性肺疾病基层诊疗指南(2018年)[J]. 中华全科医师杂志,2018,17(11):856-870. DOI:10.3760/cma.j.issn.1671-7368.2018.11.002.
[8] 田建霞,陈晓香,王继苹. 改良英国医学研究委员会呼吸困难量表评分、慢性阻塞性肺疾病评估测试评分与慢性阻塞性肺疾病患者肺功能的相关性及其对肺动脉高压的预测价值[J]. 实用心脑肺血管病杂志,2018,26(12):44-48. DOI:10.3969/j.issn.1008-5971.2018.12.010.
[9] 李静芬,田景炜,陈瑞,等. 圣乔治呼吸问卷对慢性阻塞性肺疾病患者生活质量的调查[J]. 现代生物医学进展,2016,16(36):7091-7094. DOI:10.13241/j.cnki.pmb.2016. 36.023.
[10] 陈啸,丁兆生,李佟,等. 有氧运动训练对老年慢性阻塞性肺疾病患者稳定期肺康复疗效的观察研究[J]. 国际医药卫生导报,2020,26(20):3084-3087,3091. DOI:10.3760/cma.j.issn.1007-1245.2020.20.024.
[11] Holland AE, Jones AW, Mahal A, et al. Implementing a choice of pulmonary rehabilitation models in chronic obstructive pulmonary disease (HomeBase2 trial): protocol for a cluster randomised controlled trial[J]. BMJ Open, 2022, 12(4): e057311. DOI: 10.1136/bmjopen- 2021-057311.
[12] 刘海娟,徐永伟,杨超,等. 主动呼吸循环技术联合有氧运动对于慢性阻塞性肺疾病患者肺功能改善和运动能力的改善作用[J]. 临床和实验医学杂志,2021,20(16):1753-1756. DOI:10.3969/j.issn.1671-4695.2021.16.020.
[13] 冯兵,史静琴,杨斌,等. Bio Master虚拟情景互动康复辅以组合式呼吸训练对老年慢性阻塞性肺病患者肺功能恢复的影响[J]. 实用医学杂志,2021,37(5):681-685. DOI:10.3969/j.issn.1006-5725.2021.05.024.
[14] 张伟珍,朱海虹,金冰佩.雾化吸入装置引导康复联合呼吸训练对慢性阻塞性肺疾病稳定期患者呼吸功能的影响[J].北京医学,2020,42(3):247-249.DOI:10.15932/j.0253- 9713.2020.03.019.
[15] 彭先美,欧平雪,杨燕,等. 进阶式抗阻运动结合有氧运动对稳定期慢性阻塞性肺疾病患者呼吸康复效果的影响[J]. 国际老年医学杂志,2022,43(4):429-433. DOI:10.3969/j.issn.1674-7593.2022.04.011.
[16] 闻艳丽,张玉慧,宋为民,等. 针药并用结合五禽戏对类风湿性关节炎患者临床症状和生活质量的影响[J]. 四川中医,2022,40(2):108-111.
[17] 易春芬,刘艳红,余俊红,等. 核心稳定训练联合五禽戏对颈型颈椎病患者颈椎疼痛、颈椎功能和生活质量的影响[J]. 现代生物医学进展,2022,22(1):192-195. DOI:10.13241/j.cnki.pmb.2022.01.037.
[18] 张志,张和华,张霞萍. 补肾壮骨汤联合五禽戏在糖尿病性骨质疏松症患者中的临床效果及对骨折发生率的影响研究[J]. 重庆医学, 2020, 49(S2): 123-125.
[19] 曹海豪,孙文玉,席晓明,等. 五禽戏对帕金森病患者平衡功能、步行能力及生活质量的效果[J]. 中国康复理论与实践,2021,27(9):1087-1092. DOI:10.3969/j.issn.1006-9771. 2021.09.014.
[20] 谢林艳,殷稚飞,宋丽丽,等. 五禽戏对稳定期慢性阻塞性肺疾病的肺康复疗效及应用[J]. 中国康复,2021,36(2):117-120. DOI:10.3870/zgkf.2021.02.012.